HomeMy WebLinkAboutTANK ONLY - SWG Application / Design - 4/8/2025 415 N BTH STREET,SHELTON.WA 98554
MASON COUNTY SHELTON:360.276 467.EXT 400
H LTON:340@764687,EXT 400
Public Health & Human Services ELMA:360.4024269,EXT 400
4 FAX:380427-7797
On-Site Sewage System Tank Only Permit: SWG2025.00125
OWNER CUPPOLETTI ADAM S Phone:
Address: PO BOX 364 LILLIWAUP,WA 98555
APPLICANT CUPPOLETTI ADAM S Phone:
Address: PO BOX 364 LILLIWAUP,WA 98555
SEPTIC INSTALLER JAMIE WORKMAN* Phone: 360-463-9573
Address: 120 E TIMBERLAKE DR SHELTON,WA 98584
Site Address: 1993 N Lake Cushman Rd
Primary Parcel Number: 422103490170
Permit Description: Tank-Only Repair: Replacement 3-Bedroom Septic Tank
Permit Submitted Date: 0410812025
Permit issued Date: 04/09/2025
Issued By: David Anderson
Current Permit Fees Paid: $270.00 (a,,,m ras fees may be required aeon meanatmn of syatem).
Permit Expiration Dale: 04/08/2026 (based on date of mseeaom)
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 3 Drinking Water Source: Public Water System
Additional Details: Interceptor 1260
Permit Conditions.
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
2 Pemrit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
3 Mason County Asbuilt Form,Record Drawing, and Installation fee must be submitted for
final installation approval.
4 Proposed development subject to zoning requirements and approval by the planning
department stall par Mason County Title 17.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED ANDIOR DESIGN
APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit:masoncountywa,govlhealthlenvlronmentallonsiteloss-inspection-request.php or call:
360427-9670,extension 400.
OFFICIAL USE ONLY
dRRCENEM — V 1�`� C s
MASON COUNTY ML c g
COMMUNITY SERVICES M° " M " ' ITT
Bl
PuMNHxI1N lcmmmumry NFallNEm+IonnlenWl NeNIN 0 O
m q.. R SWG
A
$ w
ON-SITE SEWAGE TANK ONLY APPLICATION m
m
PHONE F'
APP11fANi � C� Z
3
MNLINGMORESS-STREET,CNY,STATE,2IPCOOE ITT
�-?z 7B A
SITE ADDRESS-STREET.CITY.SIPLWIE A gOIf Ll
NAME OFOESONER 1 J PHONE T 'YAO IS fIN—
PIgNE l O N
NMIEOF INSTA LER
l�vr(iv cw\ h VS C C 3fnfJI —
IYPEOGNORK(WK1aM) ORINKWGMMRSWRCE
❑NEWCONSTRUCTION/UMMOES ®REPAIRIREPLACEMENT rEl
PRIVATEINDIMOUALINELL ORIWTETV PIT PA�R7J,Y WELL IZ IQ
COMPONENTI$)TO BE RFPIACEDIINSTALLED p PUSUCWATERSYSTEM 14--,Lh�TI 1
BEOROWA LOT 811E
Ip SEPTIC TANK ❑PUMP TANK ❑RV HOLDING TANK JC 3
❑OTHER L 0 I�
OTHEROETAILSRI 10 "*) TANK(S)SETBACK CNECNLIBT MI
❑ SURFACING SEWAGE m EXISTING FAILURE ❑SHORELINE is100FTPPUBLICICOMMUNITY WELLS x
Iff NET,PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
BOBMTGWs ® IOFTK DRINKING VMTER SUPPLY LINES
In PLOT PLAN(REQUIRED) O TANK CROSS SECTION(REQUIRED)
BFT-PROPERTYI EASEMENT LINES,FOUNOATN)NS,FOOTINGS
❑PUMP DETAILS(IFAPPLICABLE) O NE VMR(S)(IFAPPLICABLE) O ^_
PLOTPiARcHEmDIT 9
E7PROp,,,LRRESMDEASEMENTS DEXISTING/PROPOSED STRUCTURES ❑EXISTING/PROPOSED OSS COMPONENTSAND LINES
WELLS VATHIN IOOFT ❑WATER SUPPLY LINES ❑DRIVEWIYS/PARKING ❑SURFACE WATERS.STREAMS,RIVERS,ETC..
CI DIRECTIONOF SLOPE/GONTOURS ❑PERIMETEW CURTAMOMINS ❑NORTHARROW ❑SCALEBAR IQ
OWECiIONST09NEAND SITE CONOITIOMB(u" °BGMI `� -•-'Y, —e -
(Jw 48u , LT�'E
Cn
coslY,v o -rve
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADEINTARY 3W1AM IRa IeA C PUMP/
[]VOLUNTARY OMAINTENANCEIPUMWNG OBUILDING PERMIT CIHOME SALE 13cowww ❑OTHER:
COMMENTSICONDMONS (7 ^� Tao,
SEYAGETANKSANISTBELRTEDUNDEROO LISSTTOFL/ .ENSWREDSEYMGETANM TANKSMUSTAIEETCURRENTMINMW SIZE REWIXEMENTS.EQUIPPED WTH RISERS
MOLIOSTOSURFACE.MDWCWOEANEFFWEWF0.TER(WF PLIGBIEI. RECOR)pM4RN<ARO WSTµUTIW REPpRREOUIRED FOR FWALAPPROJAL.
INSPECTOR SIGNATURE GATE MPLICATNW EMIMTIQV Al APPLN:AT MPROVEOIISSUEDBY
10U—
THIS FORM MAYBE SCANNEDANDAVAILABLE FOR PUBLIC MEW ON THE"SON COUNTYWEBSITE REYISEOTAWDIB
@Z
qa
R0'97015
RFCFI�0
( 67Aous+[1 E"/ru. .
O 'fd»K par/AT /03
-�ruf��: �c//•w �.n ous�' C.rr 'fnt,/RS (✓/r/��'+°tL i�
alp
os
t t'e-WTzK4- �/ J
/00
�q 4P
�Nc��ryF�p0,9
0 Aq�NsgN7
a�HF91Ty
MASON COUNTY HEALTH DEPARTI/IQW
428 WEST BIRCH STREET / UL L y y901
SH:LTON, WASHINGION 98584
PHONE(206)426-5561 ;; v
RECORD OF FINAL INSPECTION OF YOUR SEWAGE DWO���//Al`S`Y�TFITL
OWNER ADDRESSR8-- 6398 //OKYA'A 9'890
Ii
THIS RECORD IS NOTAGUARANTEE OF PERFORLEGAL
MANCE. DESCRIPTION p .2' ?09.�,�'i "Fp
A SEPTIC SYSTEM IS NOT A MUNICIPAL SEWER. HOWEVER p
WITH PROPER MAINTENANCE AND CAREFUL USE OF �,��^/ /1 *14)
WATER IT CAN GIVE MANY YEARS OF TROUBLE FREE SER-
VICE. MANY PROBLEMS WITH SEPTIC TANKS ARE CAUSED SOIL
5a" ate►" ` r
BY FLUSHING EXCESSIVE AMOUNTS OF PAPER, CLOTH FIELD / X��� r
AND PLASTIC MATERIALS DOWN THE DRAIN, OR BY SIITE �Z i/p SIZE 3
LARGE AMOUNTS OF WATER FROM LEAKY FAUCETS OR DEPTH TO 7/7 - NTH �U(
FAULTY FIXTURES. WATER TABLE 6 / OF R
THE SEPTIC TANK ITSELF SHOULD BE CLEANED EVERY INSTALLER ��
TWO OR THREE YEARS DEPENDING ON THE HABITS OF THE
FAMILY, THE NUMBER Of FIXTURES IN THE HOUSE, AND SIZE
THE AMOUNT THAT A GARBAGE DISPOSAL IS USED.CLEAN- SEPTIC TANK (S) 1"
ING AT THE RIGHT TIME WILL AVOID THE RISK Of INJUR. ERTHIELD / / FEET
ING OR DESTROYING THE DRAINFIELD DUE TO SOLIDS U lW of
CARRYING OVER INTO THE DRAINFIELD. CAL' THE TRENCH AREA SQ. FT'
MASON COUNTY HEALTH DEPARTMENT FOR A LIST OF 1378
LICENSED SEPTIC TANK CLEANERS IN YOUR AREA. THE 'r y�
CLEANER CAN SERVE YOU BEST IF YOU SHOW HIM THIS DTILEEPTH 42-/f 0 CORRUGATED XRIGID ❑ CEMENT
TOTAL
RECORD WHEN HE COMES. rl ry�((r�DEPTH
HEAVY TRUCKS OR EQUIPMENT SHOULD NEVER BE CUyDS, to PIPE 4�'T DEPTH
DRIVEN OVER THE TANK OR DRAINFIELD. CONSULT THIS SPACE RESERVED FOR 5% FT.
RECORD IN CASE OF ANY BUILDINGS, DRIVEWAYS, REPLACEMENT DISTRIBUTION FIELD:
SWIMMING POOLS, OR EXTENSIVE GRADING OR FILLING + NORTH
ARE LATER CONTEMPLATED.
SHRUBS OR TREES SHOULD NOT BE PLANTED CLOSE TO _
THE SEPTIC TANK AS THEY WOULD INTERFERE WITH
CLEANING OF THE TANK. THEY CAN BE PLANTED IN THE
DRAINFIELD AREA PROVIDING WILLOWS ARE NOT USED.
THE YARD GRADE IN THE DISPOSAL AREA SHOULD BE �D�II 70 t
SUCH THAT SURFACE WATER IS NOT POCKETED ON THE
DRAINFIELD. ANY SETTLING Of THE GROUND OVER THE ,T7 � r —zo_
TRENCHES SHOULD BE FILLED IN WITH SOIL. DO NOT EX. �(•Q.Q
CESSIVELY WATER THE LAWN IN THE DRAINFIELD AREA. i »Pr
WATER EVAPORATION FROM THE DRAINFIELD IS ABOUT Q}Iut� n jyt
EQUAL TO ONE HALF INCH OF RAIN PER DAY. v00w` : i�lhl e�P'ry.Fdv 2 —1 h
FOOTING DRAINAGE, DOWNSPOUTS AND WATER !- —p (a
SOFTENER RECHARGE WATER SHOULD NOT BE CON- � Z
— I
NECTED TO THE SEPTIC SYSTEM OR DISCHARGED INTO THE
DRAINFIELD AREA.
THE TYPES OF BACTERIA NEEDED IN A SEPTIC TANK ARE Ala 20
qA
ALWAYS FOUND IN SEWAGE. THERE IS NO NEED TO A00 n �y_ iP�••�e �
YEAST OR OTHER STARTERS TO A SYSTEM. THE USE OF RE- rT Lr�
JUVENATORS OR CHEMICALS TO CLEAN A SEPTIC TAN
HAVE NOT BEEN PROVEN TO BE BENEFICIAL AND MAY BE RFC D y1pZs �lq NCp APR49
HARMFUL BY FLUSHING SOLIDS OUT OF THE TANK OR BYCHANG �NTy `9.3'i., �
THE
NORMALUSE OF BOWL CLEANERSR CLEANIG THE CHARACTERISTICS OF THE NOGILCOM- FN�IN�N,JjF"Yf SOUTH
POUNDS WILL NOT KILL THE BACTERIAL ACTION OR SLOW N
DOWN THE OPERATION OF THE SEPTIC TANK.
O By
THIS IS AN IMPORTANT DOCUMENT DATE
KEEP IT WITH DEED OR OTHER G�/ �3-/��/
ESSENTIAL PAPERS. DAIS BY
rriNFILTRATOR RFR"910?s IM-1250
septic tanks
Features 8 Bone s
Strong injection molded polypropylene construction
Lightweight plastic Construction and Inboard lifting lugs allow
for easy delivery and handling
Integral heavy-duly green lids that Interconnect with Hemp
risers,Safety Star secondary safety lid system,and pipe riser
solutions
Structurally reinforced access ports eliminate distortion during
installation and pump-outs
Reinforced structural ribbing and fiberglass bulkheads offer
additional strength
• Can be installed with W to 48"(152 to 1,219 mm)of Cover
Can be pumped dry during pump-outs
Suitable for use as a septic tank,pump tank,or rainwater(non-
potable)tank
No special water filling requirements are necessary
The tank may be backfilled with suitable native soll. See
installation instructions for guldanoe.
The Infiltrator IM-1250 is a lightweight, strong and durable septic tank. This watertight tank design is offered
with Infiltrator's line of custom-fit EZsnap risers and heavy-duty lids. Infiltrator injection molded t ks provide a
revolutionary improvement in plastic tank design, offering exceptional long-term strength and JAtness.
TANK CUTAWAY Partition baffle wall
�qs �p/LJA®�/C
°vcpUNryF�Aog�s `�
Ty
e
HEAVY DUTY LID CUTAWAY
Reinforced 24"structural
access port
Structural bulkheads
MID-SEAM CUTAWAY 4 r
Reinforced water tight INFILTRATOR
mid-seem gasketed water technologies
rnnnnrenn
IM-1250 General Specifications and Illustrations
The IM-1250 is an injection molded two-piece mid-seam
polypropylene tank. The injection molded design of
thelM-1250 allows for amid-seam joint that has precise LIFiIN STRAP"In UE"NG LUG(TVP.) RISER fANNECTION(IYP.{
dimensions for accepting an engineered EPDM gasket.The engineered mid-seam joint accepts a continuous
loop EPDM gasket. Infiltrator's EPDM gasket design 611,
utilizes technology and materials from the sanitary IE i 11
sewer pipe industry to deliver a reliable watertight seal. WIDTH
The two-piece design is permanently fastened using
a system of molded-in alignment dowels and locking --- 1W.3 ta.esei ,{o
seam clips.The IM-1250 is assembled and sold through EMERIGR LENGTH IVA
a network of certified Infiltrator distributors.be bkfilled and Installed in
04
accotrda cewiith he InfiltratorIM-antl GUTLETPIPE TOPVIE1k7sC,yCOGv Fq °Q
❑ I I',1�,1❑ CM-Series Septic Tank General (11YR) 4y
A installation Instructions.For shallow �dgg7
I•.ELI ground water conditions reference
9,IP.. ,�,. •A�:q the Infiltrator IM-and CM-Series Ii de°A
s •�1.1. Buoyancy Control Guidance,
H1138 R lH
Please visit www.inflltratorwa ncorn4P,?
or scan QR code for the late, 9 15 LIPn (ivPsmi
Information. RFCE
END VIEW
Working Capacity 1,276 GAL(4,839 L)
1,480 GAL L) ox9.o naccess PORT pI�
91
Total Capacity " �1N°uDm Ie01PsaIPMEeOARo WCORe6ses
IeifT
Airspace 16.30% amET>EE
J I
Length 164• (3,911 min) ( ' +0 - oTM slwau.
width 61.7- (1,567 mm) Pe
,I;,� �a
Leigh-to-Width Ratio 2.8:1 z rxz t
SUPPom
Howd 64.6' (1.387 mm) p1'eJ
Liquid Level 44•(1,118 mm)
invert Drop 3'(78 mm) SIDE VIEW
Fiberglass Supports 4
cOanxucas
Canparlmenh 1or2 *antTOP EustoNEwO
HUP easxEr
Maximum Burial Depth 411'(1,219mm)
Minimum Burial Depth 6'(152 mm) estNaw
on
Maximum Pipe Diameter 4-(102 mm)
Weight 4051bs(184 kg) xaaRaLunIa,ENr
rnnn Talxemma
xuE
P.o.eo.res MID-HEIGHT SEAM SECTION
ae s.kaaax.cr as,zs
eeosn-rood eu eEasn-Tour
INFILTRATORnma ,nr an
water technologies Inm®Innroalwwabrxan
rarus Ptlm4NamWlm Hailxw.iJllrzlowNa.wMwlmis.Ww p era W.f'M.aaMl«.W4YeeM E1M1wae.agcl«Mh,6nierMdmFIVaI«fuel«Txl�Wi9"�.Nwain WalerT«Fmlo9'essz
xYMyane0aWM1W asararcea paaaeesksiaw,Tc.(�SI.
®AN1f%.WaaT.t.kg uc.na�e.,P«ratb t«e'ry lkyogaakenm.RY,tetl Y,usA.
IMI15aIZA
ContactI Ig Department forIII